Urethral prolapse is a ring of urethral lining that turns outward through the urethral opening, seen mostly in prepubertal girls, more often Black girls, and in postmenopausal women. Low estrogen and bouts of raised abdominal pressure, such as coughing or constipation, are the usual triggers.
Key symptoms
- Blood spots on underwear or a diaper, often the first sign in girls
- A red or purple lump at the vaginal opening
- Painful or frequent urination, or no symptoms at all
- Discomfort when walking with a larger prolapse
What you find on exam
- Donut-shaped red to purple mass with the urethral opening in the center
- Separate from the vaginal opening; normal hymen in girls
- Dark or dead-looking tissue suggests strangulation
- Gentle exam; think about abuse if the findings do not fit the story
Tests
- Clinical diagnosis from the exam
- Urinalysis and urine culture if there are urinary symptoms
- Passing a small catheter through the center confirms the urethra
- Imaging only if a different mass is suspected
Treatment basics
- Topical estrogen cream for a few weeks
- Sitz baths for comfort
- Treat constipation or cough
- Surgical excision if the tissue is dead, large or does not respond
Red flags
- Dark, dead-looking or very painful tissue (strangulation)
- Inability to urinate
- Genital bleeding in a child when the story does not fit
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.